Background and case description: Virchow-Robin spaces are fluid filled perivascular spaces in the brain which are rarely found in asymptomatic children. Their frequency increases with age and they are associated with cognitive decline in otherwise healthy elderly. They are common in high altitude mountain climbers, mild traumatic brain injury and in certain hereditary vascular diseases. In children they are associated with mental retardation, developmental delay and headache. They have been identified in children with autistic disorder.

We describe a 28 year old female with severe catatonia, auditory hallucinations and delusions, and prominent Virchow-Robin spaces, who responded to ECT and olanzapine. Conclusion: MRI was valuable in the management of this case. While prominent Virchow-Robin spaces may have been a coincidental finding (not aetiologically significant) there was loss of brain parenchyma and we believe this contributed to the severity of the presentation and suggests a less favourable prognosis.